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CLINICAL RESEARCH: ATHEROSCLEROSIS EVALUATION BY ULTRASOUND

Stabilization of Carotid Atheroma Assessed by Quantitative Ultrasound Analysis in Nonhypercholesterolemic Patients With Coronary Artery Disease

Keisuke Watanabe, MD^_*, Seigo Sugiyama, MD, PhD^_*,_*, Kiyotaka Kugiyama, MD, PhD, Osamu Honda, MD^_*, Hironobu Fukushima, MD^_*, Hidenobu Koga, MD^_*, Yoko Horibata, MD^_*, Toshinori Hirai, MD, PhD, Tomohiro Sakamoto, MD, PhD^_*, Michihiro Yoshimura, MD, PhD^_*, Yasuyuki Yamashita, MD, PhD and Hisao Ogawa, MD, PhD^_*

^_* Cardiovascular Medicine
Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Second Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering University of Yamanashi, Yamanashi, Japan

Manuscript received November 3, 2004; revised manuscript received April 13, 2005, accepted April 19, 2005.

^_* Reprint requests and correspondence: Dr. Seigo Sugiyama, 1-1-1 Honjo, Kumamoto City, Kumamoto, Japan 860-8556 (Email: ssugiyam{at}kumamoto-u.ac.jp).

OBJECTIVES: This study examined whether intensive cholesterol-lowering therapy with statins in nonhypercholesterolemic patients is effective in improving echolucency of vulnerable plaques assessed by ultrasound with integrated backscatter (IBS) analysis.

BACKGROUND: Atherosclerotic plaque stabilization is a promising clinical strategy to prevent cardiovascular events in patients with coronary artery disease (CAD). There is a correlation between coronary and carotid plaque instability, and echolucent plaques are recognized as vulnerable plaques.

METHODS: Consecutive nonhypercholesterolemic patients with CAD were randomly assigned Adult Treatment Panel-III diet therapy (diet group; n = 30) or pravastatin (statin group; n = 30). Echolucent carotid plaques were monitored by measuring intima-media thickness (IMT) and echogenicity by IBS for six months.

RESULTS: Total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-sensitivity C-reactive protein were significantly decreased in the statin group (from 197 ± 15 mg/dl to 170 ± 18 mg/dl [p < 0.001]; from 131 ± 14 mg/dl to 99 ± 14 mg/dl [p < 0.001]; and from 0.11 [0.04 to 0.22] mg/dl to 0.06 [0.04 to 0.11] mg/dl [p < 0.05]; respectively), whereas only total cholesterol was moderately reduced (from 193 ± 24 mg/dl to 185 ± 22 mg/dl [p < 0.05]) and LDL-C and triglycerides insignificantly reduced in the diet group. Significant increases of echogenicity of carotid plaques were noted in the statin group but not in the diet group (from –18.5 ± 4.1 dB to –15.9 ± 3.7 dB [p < 0.001] and from –18.2 ± 4.0 dB to –18.9 ± 3.5 dB [p = 0.13]; respectively) without significant regression of plaque-IMT values in both groups.

CONCLUSIONS: Statin therapy is rapidly effective in increasing echogenicity of vulnerable plaques without regression of plaque size in nonhypercholesterolemic patients with CAD. Quantitative assessment of carotid plaque quality by ultrasound with IBS is clinically useful for monitoring atherosclerotic lesions by evaluating vulnerability of atheroma.

Abbreviations and Acronyms   cIBS = calibrated integrated backscatter   CAD = coronary artery disease   HDL-C = high-density lipoprotein cholesterol   hsCRP = high-sensitivity C-reactive protein   IBS = integrated backscatter   IMT = intima-media thickness   LDL-C = low-density lipoprotein cholesterol   TC = total cholesterol   TG = triglycerides

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